Does periprostatic nerve block with local anesthetic reduce pain during prostate biopsy?

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Abstract

BACKGROUND

Despite the pain associated with prostate biopsy, many procedures are performed without analgesia. Periprostatic nerve block (PNB) with local anesthesia is a popular technique, but its overall efficacy is not known.

OBJECTIVE

To determine the efficacy of PNB with local anesthesia for prostate biopsy analgesia.

DESIGN AND INTERVENTION

This was a meta-analysis of randomized studies published between 1966 and 2005 comparing local anesthetic to no block or saline placebo during prostate biopsy. Eligible studies assessed biopsy pain via the use of mean visual analogue scale (VAS) pain scores. No minimum sample size was stipulated for inclusion in the analysis. Data were collected and the overall pain scores of patients who received local anesthesia were compared with the pain scores of patients who did not. Wherever possible, an attempt was made to contact the authors of studies for which incomplete data were available. An analysis of the 'file drawer problem'-the number of unpublished studies or patients showing no difference in pain scores between intervention and control that would need to be discovered in order to nullify the results-was performed following compilation of the data.

OUTCOME MEASURES

The primary end point was prostate-biopsy pain, assessed via the VAS pain score.

RESULTS

In total, 107 relevant abstracts were found, of which 16 met the inclusion criteria. These studies included 660 patients who received local anesthesia for PNB (lidocaine, articaine, bupivacaine or mepivacaine) and 616 who did not. Half of the studies used a saline placebo and half used no block, and injection volumes ranged from 5 ml to 10 ml. The number of biopsies taken ranged from 2 to 12. For all studies, the weighted mean VAS pain score was 3.9 ± 1.5 for the control group and 2.3 ± 0.7 for the anesthesia group. For the eight studies that were blinded, the weighted mean VAS pain score was 3.9 ± 1.1 for the control group and 2.6 ± 0.5 and for the anesthesia group, respectively. There was significant variation in results across the studies (P<0.001). According to the file-drawer-problem analysis, there would have to have been 1,001 patients in whom the treatment made no difference to pain scores in order to invalidate the results.

CONCLUSION

The authors conclude that patients undergoing prostate biopsy who were administered a PNB with local anesthesia experienced significantly lower levels of pain when compared with those who received no anesthesia, and that this reduction in pain is clinically meaningful. Clinicians performing prostate biopsies are urged to consider using this technique on a routine basis.

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